Stigma in Mental Health (Part 1)

A couple days ago I was listening in on a tele-health consultation with Amy with the psychiatry registrar. She was a 24 year old female who has been diagnosed with OCD and schizophrenia.

She is of Asian decent.

After reading that on her notes I straight away went

‘Oh no.’

I continued to read her notes and my suspicious and fears were confirmed. Her mother refuses to believe she has a mental illness. When we called Amy, her tone was monotone, her affect was restricted and her thought process was rigid with an immense fixation on getting injections in the morning (I still haven’t figured out why she was so desperate for this in particular).

When speaking to her mother, the non-stop yelling of Cantonese was heart-breaking. Despite me not understanding a word she said, you can hear that she is on the brink of tears with every tremble in her voice. What’s worst is that it all had to be translated over the phone. It’s already bad enough that a translator had to get involved to try and convey everything — but the tone of the Cantonese language sounds harsh enough…

She called her daughter ‘crazy.’

Her mum was driven by the fear of losing her daughter to the adverse effects of these medications. Continuously believing that the doctors had only made her daughter an alien. Her daughter locks herself in her room, checks her body everyday, apparently rips off her clothes off for no reason, mumbes to herself, picks toilet paper… These are only some of the actions that ignites fear within the mum. I mean… fair enough. If your daughter starting doing this, you would inevitably be worried. But to us, these are text book signs of OCD and schizophrenia. But the mum refuses to believe that there is even such a thing.

Poor Amy.

Locked in her own mind, not receiving the love and support she needs. Her medical team around her simply passing the buck on who needs to treat her. Nobody wants to take initiative. The case manager is burnt out beyond repair. The registrar was thrown in the deep end thinking this was supposed to be an ‘easy’ case from the previous registrar. The consultant barely managing the case since there is only one in the clinic…

Nobody is taking a step forward to find the root cause of the problem. No family conversations. Nobody has bothered to speak to the mother about what her daughter’s mental illness is. They have just simply brought Amy into the hospital. Ensured that she was not causing any more harm to herself or others. Prescribed her a bunch of medications. And sent her off to the community to face the world.

Poor Amy.

Let me give you some context apparently of what had happened before she had a phone consultation:
Her mum simply believed that she took her daughter to the GP because her daughter was unwell. She believed it was because her daughter wasn’t drinking enough water… (sounds like the typical Asian parent to me — aka my mum). GP sent her to hospital. She got admitted into the psychiatry ward. She got filled up with meds.

From a physical stand point, her lab results look great. No side effects from the clozapine injections. But… she ‘takes’ the medications unsupervised… in her room… apparently. It’s a mystery whether she even takes it.

From a mental stand point perceived by the family, she’s extremely unwell.

We can point the finger to many people on why this situation has occurred. The lack of support from the family. The medical team for not putting enough effort into Amy’s care. But the real issues lie deeper than these superficial notions.

Namely…

1. The deep rooted stigma that is engrained within Asian culture regarding mental health
2. The burn out within health care workers causing no one having enough time, let alone energy to take care of patients to the best of their ability

Two of these issues combined creates a recipe for disaster.

A disaster that ultimately negatively impacts the lives of many, many patients.

(names used have been de-identified)